Whether the result of a longstanding illness or more recent physical injury, lacking the ability to work full-time is a particularly difficult period for anyone to endure. From worrying about finances and potential career implications to stressing over the general wellbeing of one’s family, prioritizing rest and relaxation can be very difficult to achieve during such an uncertain period.
Fortunately, there is help.
For those who qualify, long-term disability benefits can help ease the burden of remaining out of work. And while receiving such a letter from your insurance carrier is certainly a welcome sigh of relief, it is important to understand that these benefits come attached with requirements that must be met for these benefits to continue.
If you or a loved one has recently been approved for LTD benefits, here is what to do to prevent your long-term benefits from being short-lived in nature.
1. Continue treating with your doctor(s)
First and foremost, an approval letter does not represent a “pass” to ease up on the frequency in which you treat with your doctors. To the contrary, courts have ruled that an insurer is regularly allowed to investigate a claim and a long term disability insurer is allowed to change their mind and deny you at some point in the future even if they originally approved your claim.
Accordingly, it is likely that your insurer will regularly check in with you to verify that you are under the regular care of a physician, that s/he is still treating you for the issue keeping you out of work, and that your condition has not improved to the point where they decide you may be able return to work. As such, make it a point to regularly see your doctor every three to four months, if not more frequently, as your lack of regularly and appropriate treatment can be used against you to argue your treatment is not consistent with a severely disabling condition.
In short, successful LTD cases are able to generate regular trails of office v
isits, physical exams, and diagnostic test results to submit to their insurers. Neglecting to attend these appointments is, therefore, not only contradictory to the concept of remaining out of work due to serious injury or illness, but also a red flag to insurance companies seeking to terminate benefits.
2. Complete and return all LTD-related paperwork on time
While out on claim, your carrier will regularly send you forms, questionnaires, and authorizations to complete. Although this may feel like busy work, it is important to complete these forms and return them in a timely basis. Failure to do so can result in your insurance carrier suspending payments until they are received and ultimately lead to the denial of your claim. Some of the more common forms LTD recipients can expect to receive include:
Activities of Daily Living Questionnaires;
Claimant Supplementary Statements;
Disclosure Authorization Forms; and
Attending Physician Statements
If you have recently received forms to complete, make sure to calendar the date they are due back. It can also be helpful to set aside several blocks of time to work on these forms without any distractions. Remember, you are completing this paperwork so that your insurer can assess your eligibility for continued benefits. Delaying your homework can result in your benefits being unnecessarily suspended or denied.
3. Prepare for the “Any Occupation” phase of your Long Term Disability claim
In general, most Long Term Disability policies initially pay benefits if claimants are unable to complete the material duties of their “own occupations.” For individuals with medium to heavy duty jobs, it’s easy to see how this requirement can be satisfied, especially when a back or neck injury can be plainly objectified through testing.
However, after a certain amount of time (usually 24 months for most policies), this definition of disability switches from the “Own Occupation” period to the much broader “Any Occupation” definition of disability. Be sure to know when this change occurs in advance so that you can speak with your doctor about whether s/he believes your condition precludes you from performing any type of work. If so, make sure your doctors’ notes reflect why you cannot perform sedentary work, which typically involves sitting, typing, and using a computer, among other tasks.
Contact our long term disability team at Murray Law Office
Being approved for benefits does not mean your hard work is done. Regularly seeing your physicians and staying on top of requests for information can be difficult to do when you are not feeling well. Especially when your benefits are on the line, consulting with an experienced ERISA attorney can make all the difference.
To speak with an attorney today, visit our website at www.murraylawoffice.com or call us at (617) 720-4411.